12 January 2009

Non-steroidal anti-inflammatory drugs (NSAIDs)

All you want to know about the use of NSAID's in the treatment of arthritis.

NSAID’s effect on your body
They can:
1. relieve pain (analgesic),
2. reduce fever (antipyretic) and
3. reduce the inflammatory reaction (anti-inflammatory). It is exactly this property that provides the
potential for relief of pain associated with inflammation.

Name a few NSAIDs
They include the prototype, aspirin, and ibuprofen, naproxen, indomethacin, diclofenac and
ketoprofen.

Most of the NSAIDs are schedule 3 drugs according to the Medicines Control Act. Some are classified as schedule 2 drugs. The latter include ibuprofen, diclofenac, naproxen, ketoprofen, piroxicam used for treatment of pain, swelling and inflammation due to injuries or short term treatment of acute gout.

Who can benefit from NSAIDs?
People with pain when the pain is associated with inflammation.
NSAID’s can reduce pain and inflammation and therefore stiffness. The anti-inflammatory action of NSAID’s does not alter the course or progression of rheumatoid arthritis. It will not cure or halt the disease but can relieve the symptoms of pain and inflammation.

It is not recommended for pain where inflammation is not a major feature, as in osteoarthritis. Then a painkiller like paracetamol, with less toxic side-effects than NSAIDs, should rather be taken.

NSAID’s are also effective in the relief of dental and bone pain, dysmenorrhoea and headaches.

When and how do I take my NSAID’s?
During or shortly after meals and as prescribed. Never take NSAIDs on an empty stomach.
Also, drink a glass of water or other fluid with your NSAID tablets. If you are dehydrated while using NSAIDs, you might be at increased risk of renal damage.
Drink plenty of fluids when you exercise because the combination of exercise and NSAIDs increase your risk for renal damage.
They are usually taken orally as tablets or capsules, but many are available as a liquid suspension or as a suppository.

What dose do I take?
Your doctor will advise you. Usually you start off with as low a dose as possible, and then your doctor will increase it if necessary. Do not increase the dose without your doctor’s knowledge.

How long will these drugs take to work?Anti-inflammatory drugs usually work within a few hours, although the maximum benefit can take one week or longer. Allow 10 – 14 days’ treatment before deciding that a specific drug is ineffective.

What are the possible side-effects?
All NSAIDs may have adverse effects, including stomach upsets, heartburn, indigestion, rashes, headaches, and wheeziness. It can effect the kidneys, liver, haematological, immunological and neurlogical systems. The drugs can cause or worsen hypertension, heart failure, angina and renal problems.
Alert your doctor if you show any of the side-effects.
Note that NSAIDs can seriously damage the stomach’s inner lining causing ulceration and bleeding. Use NSAIDs with caution.
Don’t drive if you feel drowsy or dizzy.

Do some NSAIDs have fewer side-effects than others?
Yes.
Newer NSAIDs are likely to cause less stomach upsets, heartburn and indigestion, and are known as 'COX-2 specific' NSAIDs because of their action. But they still have the potential for other side-effects.

Who should not take NSAIDs:

You should not take them if you have a history of indigestion or stomach ulcers. If your doctor decides
that short term use of a NSAID is your best option, the concurrant use of a drug (known as a H2-receptor antagonist or a proton pump inhibitor) can protect your stomach lining.

You should not take non-steroidal anti-inflammatory drugs if you have asthma, kidney problems or take the
anti-clotting drug warfarin. Consult your doctor.

The drugs can cause or worsen hypertension, heart failure, angina and renal problems. People with heart
or renal problems shouldavoid NSAID use.

Elderly people are more prone to develop side-effects and should rather take short-acting NSAIDs in low dosages for short periods of time, only if absolutely necessary.

People who are hypersensitive to aspirin and tartrazine should not take some NSAIDs. People with nasal polyps, asthma or allergies are most at risk.

NSAIDs should not taken when joint infection is suspected. By reducing the inflammation, these drugs can mask the symptoms of infection.

Can I take other medication while on NSAIDs?
Yes and no.
Some drugs interact with NSAIDs. Let your doctor/pharmacist know what other medicines you are taking. Some NSAIDs, such as aspirin and ibuprofen, are available without prescription.
If the NSAID is not effective enough in reducing pain, rather:
1. increase the dose in consultation with your doctor, or
2. change to another NSAID, or
3. add a painkiller like paracetamol, or
4. add an opoid painkiller like codeine, or
5. add a low dose of the right antidepressant at night.

Don’t take two different NSAIDs at one time.

What about NSAID’s and pregnancy?
Avoid these drugs during pregnancy or while breast feeding. Discuss this with your doctor.

What about alcohol and NSAIDs?
Alcohol and NSAIDs can both upset the stomach, and alcohol use may aggrevate irritation of the stomach lining and consequent bleeding. NSAIDs and alcohol should never be used concurrently.

Ask the Expert

Dr Elliot Shevel - Founder and Medical Director - The Headache Clinic, (Johannesburg, Durban, Cape Town) South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team.
Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon.

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